Abstract

Aim: was to explore clinical efficacy and safety of two distal radial approach (DRA) types in primary percutaneous coronary interventions (PCI) in acute coronary syndrome (ACS) patients.

Materials and methods: 113 ACS patients with endovascular procedure that had been performed through DRA - met entry criteria. Standard DRA was performed within anatomic snuffbox in 82 patients (72,6%) and modified - on the dorsal surface of the palm (dorsopalmar type) in 31 patients (27,4%). Approach conversion was performed in 7 patients (6,2%). PCI on syndrome- related artery was performed in 94 patients (83,2%). On completion of PCI and final approach angiography, hemostasis was performed with bandage application for 6 hours. Hemostasis comfort was determined by 10 point verbal descriptor Gaston-Johansson scale. On the 5th-7th day after PCI, all patients underwent visual check, palpation and ultrasound duplex scan (UDS).

Results: procedure and fluoroscopy time, X-ray load, hemostasis comfort - didn't depend on DRA type. Examination, palpation, UDS performed on the 5th-7th day after PCI didn't reveal cases of forearm radial artery occlusion (RAO). Subcutaneous forearm hematoma (EASY III - IV) was registered in 3 cases (2,7%). RAO was registered in standard DRA group only in 4 cases (3,5%). There were no cases of access side RAO in dorsopalmar DRA group.

Conclusion: DRA modifications for PCI in ACS patients are valuable addition to classic radial approach. Dorsopalmar DRA can be considered as basic approach.

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